Medicine and Health Sciences Commons^™

Examining Pediatric Tourette Syndrome, Alyssa Orlando

Honors Projects

Pediatric Tourette Syndrome is a complex neurological disorder. Many people associate it with swearing, however in reality it is very rarely associated with that. This paper entails my own personal experiene with Tourette Syndrome and examines potential treatment options in the pediatric population.

Pediatric Acute Lymphoblastic Leukemia: A Review, Luke Geierman

Honors Projects

Acute Lymphoblastic Leukemia (ALL) is the most commonly diagnosed pediatric cancer and the most frequent cancer-induced cause of death among young people. Despite this fact, tremendous progress in treating the disease has been made in the last 50 years. This systematic literature review examines the incidence of the disease as well as the importance of risk stratification in treatment planning. The role of genetics in ALL risk stratification, specifically hypodiploidy and hyperdiploidy, is also considered. Finally, current treatment protocols, treatment failure, and the future of research and treatments are all each examined.

Chapter 14: Hospice And End-Of-Life Care, Sally Pelon, Brandon Youker, M. Paola Leon

Books and Contributions to Books

This chapter explores end-of-life issues and concerns as well as the hospice movement’s role in assisting terminally ill individuals. Specific social work assessment and interventions tools are offered considered as well as controversial issues in end-of-life care.

A Multiple Comparison Study That Test The Validity Of Varian’S Rapidplan For Prostate Cancer Cases Based On Models Built From Outside Institution., La'rone Reid

Culminating Experience Projects

In radiation oncology treatment planning techniques and outcomes can differ from one institution to the next. With knowledge-based planning (KBP) the experience of larger institutions could help smaller institutions who may not have the opportunity to encounter certain types of cancer cases. However, this scenario is only true if the KBP software is consistent with its algorithmic output. Varian's KBP software called Rapid Plan (RP) will be analyzed for algorithmic consistency. This study investigates the validity and consistency of RP models from two different radiation oncology institutions, and compare data to determine RP quality, and consistency when planning prostate cancer …

"Farewell" To Prognosis In Shared Decision-Making, Robert F. Johnson

Peer Reviewed Articles

Whether because of a cultural pattern or personal preference, palliative care clinicians encounter persons approaching the end of life who wish to limit or forego prognostic information relating to their situation. This scenario has received attention in a recent motion picture as well as a newly available advance directive modification—the Prognosis Declaration form. The ordinary expectation for end-of-life shared decision-making with a capable person is clinician disclosure of the best effort at prognostic assessment. The optimal match between the expressed values, goals, and preferences of the person with available clinician expertise is hopefully achieved. For the clinician, a person’s choice …

Developing An Evidence-Based Discharge Process For Patients On A Cardiac/Renal Acuity-Adaptable Inpatient Unit, Tami Gallagher

Master's Projects

Introduction: Readmissions continue to negatively impact patient outcomes and create a significant financial burden. Regardless of efforts to reduce readmission rates, the cost of readmission continues to increase.

Clinical Problem: All-cause, 30-day readmission rates on a cardiac/renal acuity-adaptable inpatient nursing unit ranged from 11% to 33% from July to December 2018 for patients diagnosed with COPD, AMI, HF, and sepsis. The readmission rate for the organization was 16.2% in September 2018 with a target goal of 14.8%.

Project Aim: To use quality improvement tools and an interdisciplinary team to implement the teach-back method during discharge education and a discharge preparedness …

A Quality Improvement Project To Enact Evidence-Based Guidelines To Improve Documentation Of Hemoglobin A1c For Inpatient Diabetes Populations, Karyn C. Kinney

Master's Projects

The purpose of this paper is to describe a quality improvement project aimed to improve the documentation of hemoglobin A1c in the discharge instructions for patients with a diagnosis of diabetes prior to a transition from the acute care setting. Clinical practice guidelines from the American Diabetes Association and patient education recommendations from The Joint Commission are the impetus for this process improvement. The Plan-Do-Study-Act (PDSA) model was utilized to identify, design, and implement the process change in collaboration with an interprofessional team. The documentation rate of hemoglobin A1c was measured on two medical-surgical inpatient hospital units both pre- and …

Introduction Of Auricular Acupuncture, Monica Lyons

Doctoral Projects

The overall purpose of this quality improvement project was to assess if there was an interest to add auricular acupuncture to a substance abuse program. The two guiding questions of the Doctor of Nursing Project were (a) how can auricular acupuncture be helpful when treating patients with substance abuse in a selected organization? (b) what information is needed for both staff and patients to make an informed decision regarding auricular acupuncture? The Promoting Action on Research Implementation in Health Services (PARiHS) framework was used as the theory framework for implementation of evidence-based research into an organization. The facilitator in the …

Program Evaluation Of The Impact Of Sensory Room Activities On Student Readiness In Muskegon County, Mary C. Spyhalski

Education

There is a lack of research regarding the effect of sensory room interventions and equipment on student’s school readiness, as well as a lack of research regarding documentation and monitoring the effectiveness of sensory rooms. This is a problem for occupational therapists and teachers implementing sensory interventions that are not backed by research (Stephenson & Carter, 2011). Occupational therapists in Muskegon County Northern Service Unit (NSU) have determined a need to collect data on the impact of sensory room interventions on student readiness for school-day activities within their district. Program evaluations are needed in order to gather data that discusses …

The Benefits And Accessibility Of Integrative Exercise In Geriatric Populations, Elizabeth Nisper

Honors Projects

There are many physical and mental benefits of conventional exercise and they have been well-studied. However, integrative exercise practices aim to encompass more than physical fitness. There is also a spiritual/ethical component when taking into account aspects such as meditation and mindfulness. By examining a number of different health domains, we can study whether the benefits of yoga and tai chi extend beyond the benefits of exercise more broadly. While the short-term physical fitness benefits of other cardio and strength training may exceed those of integrative practices, yoga and tai chi appear to be equally as beneficial in the long …

Global Occupational Therapists’ Health And Wellness Interventions With Community-Dwelling Older Adults, Catherine Keegin, Lyndsey Lehman, Hannah Meier, Megan Weinberg

Older Adult

Rationale: The profession of occupational therapy (OT) has an opportunity to positively impact health and wellness for community-dwelling older adults with the approaching global increase of the aging population (He, Goodkind, & Kowal, 2016). Objective: The purpose of this study was to explore occupational therapists’ use of health promotion and wellness approaches to facilitate healthy aging with community-dwelling older adults in a global context. Results: Four qualitative themes were uncovered: perceptions of older adults, safety, the role of OT, and preventive versus reactive care. Participants with 10 or more years of experience addressed spirituality in practice more often than those …

Exploring The Connections Between The Presence Of Developmental Trauma And Clinical Reasoning: The Lived Experience Of Pediatric Occupational Therapists, Gwendolyn R. Blake, Briar E. Plantinga, Julie Shafer

Pediatrics

Background: Developmental trauma is a current issue facing the nation. It adversely affects participation in occupations across the lifespan. This paper examines how the clinical reasoning of practicing pediatric occupational therapists changes when treating clients who have experienced developmental trauma.

Methods: A phenomenological approach was applied using multiple cases. Four individuals, who identified as working with clients with developmental trauma, were interviewed using a series of semi-structured and open-ended questions on their experience treating these clients.

Results: Narrative transcripts were reviewed by the authors and organized into themes of performance patterns of the therapist and the context of developmental trauma …

Program Evaluation Of The Impact Of Sensory Room Interventions On Student Readiness In Muskegon County, Emilie Brzak, Olivia Deweerd, Erica Roll

Pediatrics

Aim: This study is a program evaluation of four different sensory rooms in the schools within Muskegon County Northern Service Unit (NSU) to uncover the benefits of sensory interventions on students’ school readiness.

Methods: Grand Valley State University occupational therapy students analyzed data from the school occupational therapists to promote evidence based practice of this program.

Results: Within this program, sensory interventions increased students’ school readiness.

Conclusion: Outcomes indicate that the primary means of increasing students’ school readiness include transitioning to an active activity following sensory interventions and participating in multiple stations. Results are not generalizable to other programs.

Evidence-Based Cardiac Monitoring: A Practice Change, Joseph Paul Urbanski

Doctoral Projects

Background: Overuse of cardiac monitoring (CM) in acute care settings contributes to increased healthcare spending and cost of services for patients. Additionally, inappropriate use of CM can contribute to wastefulness of healthcare resources, increases in hospital staff workloads, and can be improved with best evidence-based practice recommendations. A Midwest acute care hospital lacked an evidence-based, systematic method to define care for patients requiring CM.

Objective: The purpose of the project was to pilot an evidence-based CM change initiative, determine feasibility for sustainment, and propose next steps for adoption of the change initiative across non-emergency department, non-intensive care inpatient CM units …

The Acute Effects Of Melatonin On Striatal Dopamine Release: Progressive Electrochemical Analysis In An Ex Vivo Mouse Model Utilizing Fast Scan Cyclic Voltammetry, Kevin D. Hughes

Masters Theses

The caudate putamen is a sub region of the basal ganglia, containing neural tracts important for cognition, reward learning, and voluntary motor function. Dopamine (DA) signaling received from the dopaminergic neurons of the substantia nigra pars compacta mediate locomotion, degradation of which is the characteristic neuropathology for Parkinson’s disease (PD). PD is an initially neurovegetative motor disorder but can progress to include cognitive impairments as well. Sundowner’s syndrome (SS) has been observed in patient populations with neurodegenerative diseases, characterized by the decline of cognition into evening hours. Due to the circadian influence which the hormone melatonin has on the sleep-wake …

Implementation Of Evidence-Based Chronic Non-Malignant Pain Management Protocol For Primary Care, Jenny E. Kipp

Doctoral Projects

Chronic pain is the most prevalent health condition in the United States and is the most common reason people seek healthcare (Chang, Daubresse, Kruszewski & Alexander, 2014). In 2012, health care providers wrote 259 million prescriptions for opioid pain medications despite little change in self-reported pain prevalence (Centers for Disease Control and Prevention (CDC) 2016; Chang et al., 2014). Initiatives to prevent the under treatment of pain have resulted in overreliance on opioids to treat pain. As a consequence of opioid centric prescribing, an opioid epidemic has evolved with devastating consequences such as dependence, addiction and overdose deaths related to …

An Integrated Model Of Palliative Care In The Emergency Department To Improve Referrals, Jennifer L. Schlatter

Doctoral Projects

Introduction: The emergency department plays a critical role in the trajectory of in-hospital patient care. The Center to Advance Palliative Care (CAPC) along with the American College of Emergency Physicians (AECP) recommend early referral to palliative care for patients with life limiting illnesses that present to the emergency department. Research demonstrates that early palliative care consultations result in patient directed goals of care, improved symptom management, decreased length of stay, and reduced direct costs for inpatient hospitalizations.

Objectives: The goal of this project was to implement evidence-based recommendations for early palliative care referrals in an adult emergency department to improve …

Final Defense: Sepsis Screening Tool Assessment At A Freestanding Children’S Hospital In The Midwest, Cassandra Cummings

Doctoral Projects

Pediatric sepsis is a major contributor to childhood morbidity and mortality. Tools for predicting sepsis in pediatric patients have had poor predictive ability nor been validated. Risk assessment screening tools are effective at earlier detection of sepsis. The implementation of an evidence-based pediatric sepsis screening tool could reduce time to detect and diagnose severe sepsis so that patient treatment could occur earlier. This was a quality improvement project that evaluated a sepsis screening tool predictive validity at a children’s hospital.

Evidence-Based Toolkit To Evaluate Telemedicine Delivery Of Palliative Care, Aubrey E. Dwyer

Doctoral Projects

Advances in healthcare have led to many individuals with cancer to live longer, however the quality of life of these individuals has decreased. Palliative care is a medical sub-specialty that can assist to care for individuals with a life-limiting illness such as cancer. However, the access to palliative care services in rural communities is limited. According to the Institute of Medicine (IOM) report Dying in America, increasing access to palliative care will not only enhance the quality of life for patients with a life-limiting illness, but also contribute to a more sustainable healthcare system. The key stakeholders within a Midwest …

Increasing Screening And Education For Human Trafficking In The Obstetric Department, Chibwe Caroline Powell

Doctoral Projects

Background: Human Trafficking, is a human rights violation with global public health implications. HT is associated with multiple health problems. Healthcare providers working in obstetrics departments are in a unique position to interact with trafficked persons. Lack of specific HT screening tools, training and education have been identified as barriers to recognizing HT victims.

Objectives: The purpose of this quality improvement project was to increase victim identification and referrals by improving screening through implementation of an interdisciplinary screening tool into the EHR workflow and providing HT education.

Methods: This project examined the impact of implementing a HT screening tool and …

Developing An Evidence-Based Supportive Services Program For Cancer Survivors In A Private Oncology Practice, Joseph Ellul

Doctoral Projects

Improvements in cancer treatment have led to a rapidly increasing survivor population. In response, multiple side effects of cancer and cancer treatment as well as the various wellness needs of survivors have been recognized. Survivorship programs have been developed to care for survivors with residual effects of cancer and the side effects of treatment; however, additional support is needed. The purpose of the project was to highlight the need for a comprehensive supportive services program for the cancer survivor population and describe the steps that were required to successfully develop the program. The clinical question addressed by the project was: …

Improving Advance Care Planning Documentation In A Home Based Primary Care Program, Emily Radtke

Doctoral Projects

Advance care planning (ACP) is an importance process of reflection and communication regarding one’s preferences for future health care (Hagen et al., 2015). Findings from research indicate that advance care planning supports patient autonomy, improves quality of end-of-life, and increases patient and provider satisfaction (Bischoff at al., 2013; Brinkman-Stoppelenburg et al., 2014). To promote advance care planning discussion, the Centers for Medicare and Medicare Services (2016) made a decision to compensate health care providers for face-to-face conversations regarding future treatment associated with serious illness, offering two new current procedural terminology billing codes for ACP. The Plan-Do-Study-Act model (AHRQ, 2018) was …

Preoperative Anemia Management In Adult Outpatient Coronary Artery Bypass Graft Surgical Patients To Improve Treatment Of Preoperative Anemia, Katherine Mills

Doctoral Projects

The transfusion of blood products can lead to life-threatening complications after surgery. In addition, blood products are a scarce and expensive resource. Even though anemia in coronary artery bypass surgery patients is currently undertreated, research has shown that the intravenous infusion of iron products, as well as a single dose of erythropoietin-alpha prior to surgery, decreases the amount of blood products used in the perioperative setting. The goal of this pilot project was to increase the number of patients screened for anemia, and if necessary, treated prior to coronary artery bypass graft surgery.

Methods: This was a practice improvement, pilot …

Evidence-Based Intervention To Improve Assessment Of Headache Pain And Its Functional Capacity, Mavjuda Saydazamova

Doctoral Projects

Introduction: Headache is a chronic pain that is challenging to properly assess in clinical practice, as it is based almost entirely on the ability of the clinician and patient to communicate. This communication is based on pain scale tools. To assess patients’ disability and pain intensity, the selected organization uses the Migraine Disability Assessment (MIDAS) screening tool. Pain intensity is measured with a Numeric Pain Scale within the MIDAS. Measuring chronic headache pain accurately, while using a very subjective and inadequate pain scale to measure chronic pain was an issue. The literature review supported replacing the Numeric Pain Scale with …

The Proliferation Of Porcine Retinal Ganglion Cells Using Pnu 282987, Rebecca Karl, David Linn

Honors Projects

The retinal ganglion cells (RGCs) from porcine eyes were extracted to work towards a potential therapy for glaucoma. There is not a known cause of glaucoma or the apoptosis of RGCs that cause the eventual blindness associated with glaucoma. The goal of this protocol is to protect the RGCs from dying by adding a nicotinic acetylcholine receptor activator to induce neuronal proliferation and protect against glutamate-induced excitotoxicity. PNU 282987 was used as the nicotinic acetylcholine receptor activator due to its neuroprotective properties. We hypothesized that we would observe the proliferation of RGCs (associated with increased cell numbers) with varying levels …

Improving Communication Of Asthma Related Care Between Pediatric Primary Care Providers And Schools, Jessica N. Heichel

Doctoral Projects

Introduction: Asthma is a life-altering chronic disease that affects many children throughout the state of Michigan. Evidence-based guidelines recommend a written asthma action plan (AAP) be given to all caregivers of children with asthma. This would include schools, but the plans are not making it there. This project focused on collecting school asthma data and designing a process change at a local clinic to send the plans directly to the schools.

Objectives: The goal of this project was to improve communication between healthcare providers and schools for children with asthma. The objectives were to increase the percentage of children with …

An Evidence-Based Toolkit For Early Identification Of Frail Inmates, Morgan A. Kochajda

Doctoral Projects

There are significant numbers of people aging and nearing end of life while being incarcerated (Richter & Hostettler, 2017). Currently the Department of Corrections (DOC) does not have a standardized process for early identification of inmates who may need increased end of life care services. A potential solution to this problem would be the use of a frailty screening tool for early identification of those inmates who may need increased resources. At this time, there is not a formalized relationship between a Midwest hospice and palliative care department and the DOC. There is a desire from leadership of the hospice …

Evidence-Based Toolkit For Reduction Of Overdose Risk In Primary Care Patients On Opioid Therapy, Katelin A. Aris

Doctoral Projects

Introduction: Opioids are powerful pain killing medications that can be highly addictive and can cause risk for overdose and even death (Michigan Prescription Drug and Opioid Task Force, 2015). Many primary care providers treat patients with acute and chronic pain, although it is recognized that many receive inadequate training in pain management and feel unprepared in the complexities of caring for these patients (Becker, Bair, Picchioni, Starrels, and Frank, 2018). To treat these patients safely, provider education and adherence to guidelines put forward by these initiatives is essential.

Methods: An evidence-based prescribing toolkit was devised using guidance from the literature …

Management Of Distress In Adult Oncology Patients, Lauren Jongsma

Doctoral Projects

Cancer related distress has the potential to negatively impact the health of the patient and their treatment outcome (Grassi, Spiegel, & Riba, 2017). As identification and treatment of distress has a positive impact on patient outcomes; the Commission on Cancer (2016) required distress screening for accreditation. Key stakeholders within a Midwest hospital system expressed a desire for the improvement in the current state of the distress screening. Thus, the scholarly paper describes the key attributes of the organizational assessment, a literature review on evidence-based distress screening tool and a quality improvement project. The Promoting Action on Research Implementation in Health …

Nurse Care Manager Impact On Type 2 Diabetes Mellitus At A Rural Primary Care Practice, Patrick Joswick

Doctoral Projects

Background: Type 2 Diabetes Mellitus is a common diagnosis managed in the primary care setting. Patients with an uncontrolled state of the condition are most vulnerable to develop complications from the disease. Consequently, type 2 diabetes remains as the leading cause of end stage renal disease and nontraumatic limb amputations.

Objectives: To improve type 2 diabetes quality measures, improve documentation of quality measures, increase the continuity of care, and create a streamlined workflow and communication within an interdisciplinary team.

Methods: Quality improvement project to establish multifaceted management of type 2 diabetes. Data on the management of care was gathered pre-/post-implementation …